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A Journal on Forensic Medicine

Frequency: Quarterly

ISSN 0026-4849

Online ISSN 1827-1677


Minerva Medicolegale 2006 March;126(1):107-21


Transfusional hepatitis. Evaluating the causal nexus

Marinelli E. 1, Zaami S. 1, Traditi F. 2, Pezzella M. 2

1 Dipartimento Medicina Legale Università degli Studi La Sapienza, Roma
2 Dipartimento Malattie Infettive e Tropicali Università degli Studi La Sapienza, Roma

In the second half of the ’70s a great deal of information was obtained on non-A, non-B hepatitis which was considered as a third form of viral hepatitis caused by one or more viruses which, in infected persons, had a chronic course like hepatitis B. Various categories of potential victims had been identified, particularly subjects exposed intraparenterally such as drug addicts and the polytransfused. Furthermore, subjects infected by non-A, non-B hepatitis in what was considered to be a sporadic fashion as no parenteral transmission route for the infection could be found, had already been identified. Retrospective examination for legal medicine purposes of the causal nexus between transfusions and infection could obviously not make use of systems based on the detection of specific antibodies as such systems were not available at the time; only indirect elements based on the behavior of the transaminases could be employed. Where this possibility was lacking, the declaration of a causal nexus remained problematic, considering the endemic nature of the disease and the chances that alternative sources of contagion (hospital forms, dental treatment, sexual contagion, risky behavior linked to the intake of drugs, tattoos, manicures) were at work. Unquestionably, as from 1990, the retrospective legal medicine investigation is more reliable, in the first place because specific antibody tests for hepatitis C were now available, but also thanks to a series of legal measures designed to ensure the traceability of donations. A series of cases evaluated for the purposes of adjudicating legal indemnity benefits or as part of further civil procedures is presented and it is shown that, although a criterion for evaluating a rational and shared causal nexus was available, such evaluation did not always correspond - in practice - to sound scientific criteria. It is pointed out, finally, that the evaluation of the causal nexus does not cover all the legal medicine problems of a civil nature in so far as it presupposes the identification of the responsibility of single operators or of a structure linked to the failure to respect the procedures set out in the specific legal regulations which at times do not exist even when all the criteria for attributing the causal nexus to the suspected transfusional practice are met.

language: Italian


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